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Researchers Report Link Between Antibiotic Use and Hemolytic Uremic Syndrome

Jane L. Miller

Hemolytic uremic syndrome develops in about 15 percent of North American children with gastrointestinal infections caused by Escherichia coli O157:H7. Studies suggest that antibiotic therapy may not hasten the resolution of this infection. Now there is stronger evidence from a prospective cohort study for not using antibiotics: Antibiotic therapy may place children at increased risk for hemolytic uremic syndrome.

In the June 29 issue of the New England Journal of Medicine, researchers report the development of hemolytic uremic syndrome in 5 of 9 children given antibiotics for E. coli O157:H7 infection versus 5 of 62 children who did not receive antibiotics. Clinical and laboratory characteristics of the children who received antibiotics and those who did not were similar. 

[Because of the potential clinical implications of the findings, the journal's editors released the article 31 days early. See

Three variables were associated with the development of hemolytic uremic syndrome: a higher initial white blood cell count, a shorter time between the onset of diarrhea and the initial stool culture, and administration of antibiotics. Multivariate analysis, adjusted for the first two risk factors, showed that children who received antibiotics were at higher risk for hemolytic uremic syndrome than children who did not receive antibiotics (relative risk, 17.3; 95 percent confidence interval, 2.2--137). 

The researchers recommend that antibiotics not be given to children who might be infected with E. coli O157:H7 until stool cultures show that the pathogen is an organism appropriately treated with antibiotic therapy and not E. coli O157:H7.